Physicians, Business, Professional and Information Technology Communities
Networking to Restore Accountability in HealthCare & Medical Practice
Tuesday, April 27, 2004
Medical Tuesday refers to the meetings that were traditionally held on Tuesday evenings where physicians met with their colleagues and the interested business and professional communities to discuss the medical and health care issues of the day. As major changes occurred in health care delivery during the past several decades, the need for physicians to meet with the business and professional communities became even more important. However, proponents of third-party or single-payer health care felt these meetings were counter productive and they essentially disappeared. Rationing was introduced in this country with HMOs, under the illusion that this was free enterprise. Instead, the consumers (patients) lost all control of their personal and private health-care decision making, the reverse of what was needed to control health care costs and improve quality of care.
We welcome you to the reestablishment of these MedicalTuesday interchanges, now occurring on the world wide web. If this newsletter has been forwarded to you or you have not been on our email list, please go to www.MedicalTuesday.net and subscribe to continue to receive these free messages on alternate MedicalTuesdays. At this site you can also subscribe to the companion quarterly newsletter, HealthPlanUSA, designed to make HealthCare more affordable for all Americans. Please forward this message to your friends. If you do not wish to receive these messages, we have made it easier for you to unsubscribe simply by clicking the Remove Link below.
In This Issue:
1. Consumer-Driven Health Care
2. Culture of Blame Perpetuates Medical Errors
3. Fumbling the Handoff
4. How Can Competitive MarketPlace Medical Care be More Cost Effective?
5. Medical Gluttony or Excessive HealthCare Costs
6. Overheard in the Medical Staff Lounge
7. Medical Myths - Is the Atkins Diet Healthy?
8. The MedicalTuesday Recommendations for Restoring Accountability in Medical Practice, HealthCare and Government
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1. Consumer-Driven Health Care
Joel B Finkelstein, reporting in the Government and Medicine Section of American Medical News, states that insurers and employers are increasingly moving toward plans that put patients in the driver's seat. Businesses large and small are latching onto the concept of consumer-driven health care, which shifts more of the responsibility for health-spending choices onto the patient. "We see a 15 percent reduction in drug spending right out of the chute within five to six months and a 6 percent reduction in physician visits," says Mike Parkinson, MD, chief medical officer for Lumenos, an Alexandria, VA-based health insurance company offering consumer-driven plans across the country. "You know that 20 to 25 percent of doctor visits are unneeded; 30 to 35 percent of all health care is ineffective or inefficient. How better to get at [that waste] than front-loading the consumer who says I want to get the care I want when I want it and from whom I want it," he said. Consumer awareness of price and quality information will drive competition among physicians seeking to offer the highest value services, Dr Parkinson said. Many physicians like consumer-driven plans because they emphasize preventive and behavioral services that support doctor-prescribed treatments and make for healthier patients, he said. "What these plans are asking [patients] to do is to ration their own care," said Dwight McNeill, an expert in quality measurements and improvement at the Agency for Healthcare Research and Quality. "The question now is, do consumers, as rationers or deciders of their own health care, have better or more useful information to make these decisions than doctors did in managed care," he said.
Although McNeill says the answer has to be no, his question is tainted and totally misleading. It's not the consumer vs the doctor, it's consumers versus the managed care organization which is currently the decider of care. When consumers relate only to their doctors what they believe to be best for their health care, they make better choices by listening to the physician's reasoning rather than a remote managed care organization that polices and modifies each doctor's decision, order and even prescription. Their first interest in the decision or transaction is a financial one, not a medical one.
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2. Culture of Blame Perpetuates Medical Errors
According to Jane Salodof MacNeil in Internal Medicine News quoting Drs Kaveh G Shojania and Robert M Wachter, terrible errors happen every day in the nation's health care system. Dr Shojania sent a 29-year-old man home from the emergency room with a prescription for codeine and a diagnosis of "rib trauma and gastritis" after falling in the shower. Two days later, the patient was back in the hospital for an emergency cardiac catheterization. Dr Shojania had missed a major heart attack. "Our instinct at the time, like all doctors, was to blame ourselves after we screwed up," said Dr Wachter, chief of the medical service at the University of California San Francisco (UCSF) Medical Center. They tell their stories in a new book, Internal Bleeding: The Truth Behind Americas Terrifying Epidemic of Medical Mistakes (Rugged Land, 2004). http://www.ruggedland.com/alltitles.html. They contend that mistakes are inevitable, and cannot be prevented without a culture shift to an aviation-industry mind set that roots out and corrects all the causes behind an accident. "We can't begin to fix this problem until we give ourselves a break, by recognizing that sometimes bad errors are committed by good, committed physicians."
We would seriously question whether any aviation-industry mind set could come up with a protocol that would have picked up a cardiac risk in a 29-year-old patient with chest trauma and an obvious cause for chest pain. We have requested a copy of this book for our own critical analysis and possible posting of a book review on our electronic journal website, HealthCareCommunication.Network (www.HealthCareCom.net). We will keep you posted.
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3. Fumbling the Handoff
Dr Wachter, the author mentioned above, is one of the founders of the hospitalist movement of which there is controversy over whether it has improved care or caused its own health care communication problems. In an excerpt from their book in the above article, Drs Wachter and Shojania tell the story of Joe Silber, a 43-year-old mechanic and racquetball player, who went to a hospital emergency room with chest pains. The ER doctor ordered an x-ray, ECGs and other tests. Twelve hours later, unaware that an x-ray had been ordered, another doctor discharged Mr Silber with a clean bill of health. Meanwhile the hospital's radiologist had reviewed the x-ray and noticed a small lung nodule. Since the attending physician was not the patient's regular physician, the report was called to the primary physician's office and a paper version was sent as a backup. The primary physician's partner received the report and routed it to the patient's doctor, Dr Hewitt, who never saw the report. "Two years later, Joe Silber developed a chronic cough and a repeat chest x-ray revealed an obvious lung nodule. The radiologist's report read, 'the nodule is markedly enlarged compared to the one seen on the x-ray of October 18, 1999.' That was the first Dr Hewitt had heard of the prior x-ray, and it was too late. Eighteen months after that, Joe Silber was dead - another victim of lung cancer."
Although this is a tragic story, what seems to have been overlooked is that the attending physician during the hospital stay was not the patient's doctor but presumably the hospitalist assigned to the case. If Joe Silber's doctor during the hospital stay had been his personal physician, as would have been the case before Dr Wachter's hospitalist movement took inpatient responsibility away from the patient's primary physician, there would have been no need for the "Handoff" of medical care. And there would have been one less potential source of error in health care.
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4. How Can Competitive MarketPlace Medical Care be
More Cost Effective?
Last week, a patient brought in a her laboratory claim to show me how great managed care and Medicare were and how she was saving so much money. She showed me a bill from the laboratory that was $446.75. There was also $365.18 that was disallowed by Medicare, leaving only a $81.57 balance. Since this was part of the annual deductible, her Medigap insurance would pick up that portion and she would have no costs. Such a deal!
Let's take a closer look. The private, non-Medicare lab across the hall does the same laboratory work for $170. If Medicare regulations and mandates were not forcing laboratories to take massive cuts or be fined or go to jail, the free market would seek the lowest possible cost. What fails to be noted is that all branches of health care are at war with each other, with Medicare guns having the largest caliber of lethality. Without the "guns" of law and with only the competitive market reducing the price of the laboratory tests, the above laboratory would see a dramatic drop in business and revenue with the first patient who would immediately go across the hall for the $170 charge, rather than paying $446.75. The first lab would meet the price immediately, cut some costs, and then the law of supply and demand would further reduce the charges to a fair, affordable and sustainable price. From observing other situations, the charge after a few months would possibly stabilize at about $95 on each side of the hall. And the uninsured would have an 75 percent drop in their charges and their once-a-year health care laboratory costs would sink below their weekly grocery bill. What a bargain, except government (Medicare) interference prevents it.
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5. Medical Gluttony or Excessive HealthCare Costs
Mrs Lopez, a 47-year-old lady, developed some discomfort in her chest which was aggravated by deep breathing, using her left arm, or twisting her body. When her daughter heard that it involved the chest, she rushed her mother to the emergency room for a cardiac evaluation. Although none of those symptoms would suggest cardiac disease, the patient did, in fact, obtain an electrocardiogram, echocardiogram, cardio-lite scan, CT of the chest and a number of laboratory tests, all of which were normal. She was advised to report to me the next day. At that time, she had tenderness in the costochondral junctions (where the ribs attach to the breast bone) and in the pectoral and trapezius muscles, the large muscles that control the shoulder. This is a common result of strain in the left shoulder and arm muscles. My placing pressure on the costochondral areas reproduced the pain for which she spent over six hours in the emergency room. This maneuver confirmed it was the musculoskeletal portion of her chest wall and nothing inside the chest, such as the heart or lungs.
I asked the patient if she really felt that it was her heart, and she said it never occurred to her. She had come up with the same cause that I did, but it sure made her daughter feel much better to have all those fancy tests done, and it only cost the $25 copayment. She was totally oblivious to the real costs of approximately $2500 dollars. The treatment, of course, was routine anti-inflammatory analgesic medications such as aspirin, acetaminophen, or non-steroidal anti-inflammatory drugs (NSAID) or approximately $2.50.
The prevention of excessive health care costs is multifactorial. There is no solution that can be placed in a directive, flow chart, treatment protocol or nurse online program. This patient was part of a highly regulated health maintenance organization, and nothing she did fell outside of these regulations and treatment protocols. The answer, although very simple, is generally not appreciated. Every patient needs a personal physician to help navigate the health care conundrum. Her problem is rather straight forward and can easily be diagnosed with a phone consultation. A $25 telephone consultation, if allowed, could have put this lady and her daughter at ease and save the system the $2500+ six-hour emergency room visit, a 99 percent savings. Current regulations and health-care mandates do not allow such economies.
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6. Overheard in a Medical Staff Lounge
Dr Wallace, an oncologist, said he was at a meeting in Europe and happened to run into one of his welfare patients, whom he was treating at taxpayer's expense. After an initial glad hand greeting, the patient recognized his oncologist's surprise and quickly explained, "Oh, my children paid for this vacation." Isn't it a travesty that families are able to impose on the goodness of taxpayers and a healing profession and then subvert these additional funds from needed lifesaving care for pleasures that others who pay for their own health care cannot afford?
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7. Medical Myths - Is the Atkins Diet Healthy?
"One of the vice presidents of Tufts University posed the following questions. Is it possible to do the Atkins diet healthfully? And if not, is there a way to tweak the low-carbohydrate plan to make it more nutritious for those people who want to try it to lose weight?
"With Dr. Atkins' New Diet Revolution on the New York Times bestseller list for six and a half years straight with no sign of its sales letting up, we thought the answers to those questions would be more than timely. So we ploughed through the book - again - to see whether there was any way to reconcile Dr. Atkins' weight-loss instructions with the principles of good nutrition accepted by the health-promoting community at large."
If you or your family or patients are into diets, you might go to Tufts University Health & Nutrition Letter at http://www.healthletter.tufts.edu/issues/2003-12/atkins.html to read how they come to the following conclusion: "So, as to whether it's possible to follow the Atkins diet healthfully or tweak it to make it safe and healthful, the answers are no and no." The newsletter is not only worth reading, but consider subscribing or reading online and printing out for your friends and patients if you are a physician. I have a copy in each exam room for my patients.
For more on the Atkins high-cholesterol diet see
(http://www.medicalnewstoday.com/index.php?nfid=12272&newsid=7400). For other latest Medical News Headlines, please see http://www.healthplanusa.net/MedicalNews.htm.
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8. MedicalTuesday Supports These Efforts of the Medical and Professional Community in Restoring Accountability in Medical Practice, HealthCare and Government
John and Alieta Eck, MDs, for their first-century approach to twenty-first century problems. Please click on their Statement of Mission at www.zhcenter.org. For their article, Are you really insured?, go to http://www.healthplanusa.net/AE-AreYouReallyInsured.htm.
Madeleine Pelner Cosman, JD, PhD, Esq, for her efforts in restoring accountability in health care. For her response to charity and altruism, please go to http://www.healthplanusa.net/MPCosman.htm. You can also click on links to view some of her articles that highlight the government's efforts in criminalizing medicine, the introduction to her new book, Who Owns Your Body, and other articles that are important to the practice of medicine and health care in general.
David J Gibson, MD, Consulting Partner of Illumination Medical, Inc, for his contributions to the free and competitive Medical MarketPlace. His series of articles in Sacramento Medicine can be found at http://www.ssvms.org and additional articles, such as Health Care Inflation, at http://www.healthplanusa.net/DGHealthCareInflation.htm.
PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and personal internist, provides prompt, affordable, quality health care through payment at time of service for many of the illnesses treated in doctors' offices and for injuries treated in Emergency Rooms at a fraction of the usual emergency room fees. For a listing of his awards, publications, letters to politicians and fees and payment policy, see www.emergiclinic.com. Read Dr Berry's response to Physicians Support of Single-Payer Health Care or Socialism at http://www.delmeyer.net/hmc2004.htm#by%20Robert%20Berry.
Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), www.sepp.net, for making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals, with a special page for our colleagues in nursing. Several free newsletters are available. Be sure to follow the series on the chronology of socialized medicine to remain informed about the efforts to take over health care, detrimental to patients. Be part of protecting and preserving what is right with American Healthcare - physicians, nurses, pharmacists, psychologists, all health professionals and all concerned individuals are urged to join.
Dr Vern Cherewatenko for success in restoring private-based medical practice which has grown internationally through the SimpleCare model network, www.simplecare.com. Any patient or provider may become a member of SimpleCare. There is a section on Functional Medicine and one on Complementary and Alternative Medicine, a practice that is becoming increasingly popular. If you missed the AP article on April 4 earlier this month, find out why more patients are switching from a comprehensive health plan with $300 monthly premiums to a catastrophic plan that costs $75 a month, with a $2,000 deductible. The patient pays out-of-pocket for routine checkups, and his insurance will kick in if he ever needs extensive care. You may still see it at http://apnews.myway.com/article/20040404/D81O7R7O0.html.
Dr David MacDonald started Liberty Health Group, www.LibertyHealthGroup.com, to assist physicians in controlling their own medical benefit costs for their staff and patients. For traditional health insurance problems and traditional solutions, see http://www.libertyhealthgroup.com/1106.html. Then click on Liberty Solutions to see how appropriate consumer-directed solutions reward the patients. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.
Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, MD, write an informative Medicine Men column that is now at NewsMax. Please log on to read or subscribe at http://www.newsmax.com/pundits/Medicine_Men.shtml. See last week's column on "Free or Not Free to Treat Pain," where medicine and law intersect and where some of the most intimate aspects of human life come into contact with the raw coercive power of the state, at http://www.newsmax.com/archives/articles/2004/4/14/141600.shtml. This week's column is on Barbarian Medicine with the Medicine Men giving the Caduceus Award to "The Barbarian Invasion," released by Miramax to American theaters in November 2003. "If a picture equals a thousand words, then this film equates to millions of words. It is a tribute to the Canadian film makers that they beat Los Angeles to the hospital floor on the issue of humane pain management." The column can be found at http://www.newsmax.com/archives/articles/2004/4/21/175945.shtml.
Dr Richard B Willner, President, Center Peer Review Justice Inc, reports his latest success story and the secret of helping doctors keep their medical license. On a daily basis, doctors are reviewed, are suspended, lose their medical licenses and go to jail on trumped-up charges. These "Extra"-legal services are necessary services that your lawyer does not offer. Stay posted with a wealth of information at http://www.peerreview.org. "The Center for Peer Review Justice now has a Joint Venture Partner so we can offer Headhunting for those MDs who have been DataBanked and cannot find a new job. Our partner is a firm of some 20 years of experience. This is a fee-based service where the fee is paid by both the doctor and facility."
Semmelweis Society International, W. Hinnant, MD, JD, President, is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noted that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848 no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. He then went to St Rochus Hospital in the city of Pest and reduced the epidemic of puerperal fever to 0.85 percent. The rate in Vienna was still 10-15 percent. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: All we ask is that peer review be done with clean hands. To read the article he wrote for Sacramento Medicine when I was editor in 1994, see http://www.delmeyer.net/HMCMisc.htm#by%20Verner%20Waite%20and%20Robert%20Walker. For Attorney Sharon Kime's response, see http://www.delmeyer.net/HMCMisc.htm. For the current website please go to http://www.semmelweissociety.org.
The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to scroll down to departments and The "AAPS News," written by Jane Orient, MD, and archived on this site, providing valuable information on a monthly basis. This month she has an important article on the Robert Wood Johnson Foundation's (RWJF) claims that 44 million Americans have to "live without health coverage," and 1,000 events are planned to dramatize their plight. Medical students will organize "teaching events"; thousands of clergymen ("faith leaders") will tell their congregations that "health care for all is a moral imperative"; and a major paid advertising campaign will bolster the events. While 43-44 million sounds like a crisis number, the actual number of uninsured could range from around 10-12 million (about 3-4 percent of the population). Scroll further to their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, and the Editor-in-Chief. Be sure to follow the section on Medical Controversies and Analysis with a current article "Bias in Recent Papers on Diets and Drugs in Peer-Reviewed Medical Journals."
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Stay Tuned to the MedicalTuesday.Network and Have
Your Friends Do the Same
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If you would like to participate in this informational campaign on behalf of your patients or the Healthcare community, please send your resume to Personnel@MedicalTuesday.net.
If you would like to participate in the development of the affordable HealthPlan for All Americans, please send your resume to Personnel@HealthPlanUSA.net.
Del Meyer, MD, CEO & Founder
P.J. O'Rourke: "If you think health care is expensive now, wait until you see what it costs when it's free."
Will Rogers: "I don't make jokes. I just watch the government and report the facts."
See some recent postings below.
Charles B Clark, MD: A Piece of the Pie: What are we going to tell those bright-eyed little boys and girls who are going to be the doctors of tomorrow? When there isn't anything left for them, are we going to tell them we didn't fight because the changes were inevitable anyway? What are we going to say when they ask us why we laid down and died when things got a little tough? Are we going to feel good about ourselves when we tell them its all right because we got a piece of the pie? Read Dr Clark at http://www.healthcarecom.net/CBCPieceofPie.htm.
Ada P Kahn, PhD: Foreword to "Encyclopedia of Work-Related Injuries, Illnesses and Health Issues." Dr Kahn came to Sacramento recently and I joined her on a Channel 31 interview about her book. I was privileged to write the foreword which we've posted at http://www.delmeyer.net/MedInfo2004.htm To purchase the book, go to http://www.factsonfile.com/ and type in KAHN under search.
Tammy Bruce: The Death of Right and Wrong. To
understand the difference between the right and the left on our culture and
values, see http://www.townhall.com/bookclub/bruce.html.
Reviewed by Courtney Rosenbladt
Henry Chang, MD: WEIGHT LOST FOREVER - The Five Second Guide to Permanent Weight Loss suggest daily weights to stem the weight loss before it becomes a problem and, if it does, how to take it off and keep it off. Read our review at http://www.healthcarecom.net/bkrev_WeightLostForever.htm.
On This Date in History - April 27
On this date in 1937, Social Security made the first benefit payments under the SS act of 1935. Although some may look on this as security for old age and disability, many today are beginning to realize that government security is always very tenuous and that Americans have simply borrowed or perhaps stolen their retirements from their own children and grandchildren. It should be noted that with appropriate leadership coming from the White House in the 1930s, private investment would have made Americans more secure in their old age. Attempts to privatize social security are meeting major resistance even though the data and experiences in countries such as Chile indicate that investing even one-half of our social security taxes in the private free market would make most of us millionaires after forty years, when we retire. And if we were lucky, only investing our $2000 IRA for five years in Microsoft when it was formed would have grown to more than a million dollars, or for five years in Intel when it was founded would have increased to more than two million dollars prior to this temporary economic downturn. Thats with using less than one-fifth of our social security taxes with three times the benefits. And we could do that without social security or government involvement to make it tax exempt.
Government involvement in our retirement has injured
three generations of Americans during these 75 years, with no signs of letting
up. Let's make sure that government doesn't take over more of health care and
cause even more devastating injury to our generation, and to the future
generations of our children and grandchildren.